Internal Medicine

A woman in her 60s with a history of diabetes mellitus, hypertension, and hypothyroidism presented to the emergency department after being found confused, non-verbal, and with low urine output in a nursing home. Her last known well was around 6 a.m. before presentation. Her temperature was 94.5°F, blood pressure (BP) was 179/80 mm Hg, heart rate (HR) was 50/min, and saturation was 97% on room air. She was cold to touch. The lungs were clear to auscultation bilaterally. She was noted to have gaze preference initially to the right, then to the left, right-sided weakness, and left facial droop. A code stroke was activated; however, the CT head showed no acute pathology. Laboratory results were significant for white cell count of 12,500 cells/mm3, and a PH of 7.35. An hour later, her BP dropped to 88/50 mm Hg and HR was 42/min with no rectal temperature measurement detected despite multiple attempts. The patient was started on intravenous fluids (IVF). Her ECG on presentation and an hour later are shown in Figure 1A, B. (Already shared)

What's the diagnosis and what would you do next?

 A. Urgent transcutaneous pacemaker placement 

B. Emergent percutaneous coronary intervention

C. Active rapid rewarming 

D. Active slow rewarming 

E. Urgent hemodialysis